Better Ways to Pay for Health Care

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Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care.  Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.



Add-on health care provider payments

This chapter explores the implementation of additional payments for health care providers, tied to particular objectives or requirements. Specifically, it looks at how additional payments have been introduced to incentivise or facilitate co-ordination, and how they have been used to encourage improvement in performance, also known as “pay for performance” or P4P. The chapter follows a standardised analytical framework to explore policies in select OECD countries, notably the ENMR programme from France, cardiovascular disease care in Germany, the introduction of Family Health Units in Portugal, the diversification of payment methods for primary care practitioners in Ontario, Canada, and the introduction of a performance-based component to hospital budgets in Norway. Best practice and lessons for other OECD countries are highlighted, focussing on the extent to which these forms of innovative payment can be said to contribute to cost savings and quality improvement, as well as other health policy objectives.


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